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<meta name="description" content="直播时间：20190823家庭美白牙龈溃疡，不舒适的主要原因是美白托盘。第四章：复杂病例牙医指导下的家庭美白技术a.四环素牙（轻中度4-6个月每月复诊）b.牙齿多发变色（个性化美白方案）第五章：家庭美白的副作用和问题1.概述：美白治疗副作用轻微且持续时间短，美白结束很快消失（到目前没有牙髓炎情况）2.牙龈软组织刺激；症状：戴用数天后自感牙龈疼痛（是否药物过多及需要调整托盘）3.味觉改变；症状：口内">
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        <p>直播时间：20190823<br>家庭美白牙龈溃疡，不舒适的主要原因是美白托盘。<br>第四章：复杂病例牙医指导下的家庭美白技术<br>a.四环素牙（轻中度4-6个月每月复诊）<br>b.牙齿多发变色（个性化美白方案）<br>第五章：家庭美白的副作用和问题<br>1.概述：美白治疗副作用轻微且持续时间短，美白结束很快消失（到目前没有牙髓炎情况）<br>2.牙龈软组织刺激；症状：戴用数天后自感牙龈疼痛（是否药物过多及需要调整托盘）<br>3.味觉改变；症状：口内有金属味道（数小时会消失）<br>4.牙齿对温度敏感（最常见副作用）；症状：戴2-3天后出现<br>a.晨起取下托盘后出现敏感告知正常的（约4h慢慢消失，建议低浓度开始先脱敏凝胶）<br>b.轻微敏感的漂白过程中使用脱敏剂配合<br>c.敏感严重的停止使用2周护牙素或脱敏凝胶脱敏。<br>第七部分 家庭美白托盘的制作<br>第一章 理想美白托盘应具有的特性<br>a.具有足够的强度，避免患者使用期间出现破损<br>b.使用时不变形，储存时不变形<br>c.被动就位，舒适，就位后患者不感到过紧<br>d.易于就位，治疗结束后易于取下<br>e.由生物惰性材料制成<br>f.不对软组织、牙龈、粘膜、舌及牙齿产生刺激<br>g.不过多压迫牙龈乳头<br>h.足够薄，便于患者适应<br>i.光滑，高度抛光，无锐利粗糙边缘<br>j.使用时不磨耗<br>k.不伸展到过深的倒凹内<br>l.固位良好易于清洗<br>第二章 托盘设计的特点<br>第一节 托盘的形状分类及特点<br>1.全前庭托盘<br>2.带储存区托盘<br>3.不带储存区托盘（主要使用）<br>4.有泡沫衬里托盘<br>5.开窗或不开窗托盘（用于个别牙，特别是个别活髓牙变色使用）<br>6.扇贝型或解剖式托盘<br>7.非扇贝型托盘（2mm，用于下颌唇舌侧和上颌腭侧）<br>8.短边缘型托盘（短1mm，用于牙根暴露，牙龈退缩，牙颈部敏感）<br>第二节 托盘储存区功能优势及不足<br>1.定义及远期效果<br>a.定义：美白托盘内的空腔或间隙容纳美白剂的区域。<br>b.制作方法：在牙面涂布一定厚度的树脂或不同颜色石膏<br>c.储存区位置：距龈缘1mm<br>d.远期效果：与无储存区的托盘没有区别，但术后敏感更多，药量也要更多。可能影响咬合。<br>2.优势与不足<br>优势<br>a.更好的储存美白剂有利托盘固位<br>b.粘度高的美白剂避免渗透延长接触时间。<br>c.避免溶解并承载更多美白剂延长活性时间。<br>d.避免患者出现紧锢感。<br>不足<br>a.托盘固位力变差<br>b.需要更多的美白剂才能填满<br>c.可能对对颌产生干扰。<br>d.需要额外的物品和花费更多的时间<br>3.是否放置储存区的考虑<br>a.美白剂的粘稠度<br>b.牙齿的解剖<br>c.牙齿的变色程度<br>d.颈部变色程度<br>第三节 托盘厚度要求<br>形状：圆膜片<br>质量：要好的。<br>a.患者有夜磨牙习惯建议使用1.5mm厚度<br>b.正常使用标准厚度标准厚度1mm英寸厚度<br>c.TMD患者可以将咬合面磨除或者使用牙贴<br>第四节 总结<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/01.png"><br>第三章 石膏模型的准备<br>压膜机有正压和负压两种。<br>负压压膜机需要石膏底座要平，下颌较上颌要容易。<br>1.检查气泡修整成马蹄形约20mm厚<br>2.均匀涂布石膏硬化剂<br>3.吹干石膏分离剂<br>第四章 托盘制作的工具<br>压膜机，刀片，酒精喷枪等。<br>第五章 托盘制作的十个步骤<br>1）制取高质量的藻酸盐印模<br>2）灌制硬石膏或速硬石膏模型<br>3）修整石膏模型（与牙合面平行的马蹄形）和模型边缘<br>4）涂布间隙树脂层（不做）<br>5）固化间隙树脂层（不做）<br>6）涂布模型封闭剂或分离剂（有利于托盘取出）<br>7）选膜片（根据实际情况1-1.5mm）<br>8）真空压膜机压膜<br>9）修整托盘（平龈常用，短1mm敏感，长1mm颈部变色）<br>10）抛光托盘<br>第八部分 诊室强效美白<br>第一章 诊室美白的定义和起源<br>1.定义：又被称为诊室专业美白，由牙医在椅旁使用高浓度的过氧化物对变色牙列进行美白治疗。<br>2.起源：1864年开始。<br>第二章 美白治疗计划<br>第一节 临床和影像学检查<br>1）全面口腔检查（是否需要洁治、旧充填体、软组织）<br>2）观察牙齿敏感情况<br>3）X光片观察根尖情况（有炎症会加重）<br>4）初步分析原因<br>第二节 诊室美白的病例筛选<br>分类一 轻至中度外源性着色（标准患者）<br>a.饮食色素沉着（茶、酒、咖啡）<br>b.口腔卫生不佳、吸烟、漱口水（氯己定）染色<br>c.轻度增龄性变色<br>分类二 严重外源性染色至轻度内源性变色（一般适合）<br>a.外伤导致的牙髓出血变色<br>b.轻度内源性变色活髓牙髓腔无明显钙化<br>c.外伤死髓牙内漂白结合外漂（可能多次）<br>分类三 中至重度内源性变色（不适合）<br>a.严重内源性变色的单颗死髓牙（内漂）<br>b.钙化活髓牙（家庭美白）<br>第三节 确定期望值（诊室美白的不足与优势）<br>不足：治疗费用较高，术后敏感可能性大<br>优势：可以取得立竿见影的效果<br>最新美白研究：<br>a.10%的过氧化脲美白一周<br>b.38%的过氧化氢诊室美白45分钟<br>c.28%的过氧化氢诊室美白1小时<br>d.a,b,c结果一致。<br>第三章 诊室美白材料的选择<br>1.按组分分类<br>a.单组分类（光激活）<br>b.双组份类（光激活）<br>c.双组份类（化学激活）<br>2.按成分分类<br>HP<br>第四章 美白光源设备（有争议，尚无定论）<br>不用了。<br>第五章 美白监测<br>医护最好治疗过程全程都在。<br>第六章 诊室强效美白的技术流程<br>1.托盘印模<br>a.完成诊室美白继续家庭美白<br>b.诊室美白反弹降到最低<br>c.可作为脱敏使用<br>2.常规洁治抛光<br>a.去除色素和软垢及菌斑<br>b.可预测术后敏感程度<br>c.如出血严重美白在2周后。<br>3.术前比色<br>a.记录术前颜色<br>b.以利术后比对<br>4.护目镜和光罩<br>a.保护眼睛<br>b.防止光散射<br>5.口唇牵拉和防护<br>最好用专业开口器<br>a.建议使用同时保护上下口唇<br>b.撑开力量柔和并阻挡舌<br>c.最好可消毒降低成本<br>6.牙龈隔离<br>a.唇颊前庭放置长棉卷<br>b.暴露牙龈5-10mm<br>c.折叠纱布保护颊侧组织<br>d.暴露前牙和前磨牙<br>e.扇贝型涂布保护剂<br>f.缓慢移动固化灯避免产热<br>g.根方延伸5-10mm连接棉卷<br>h.牙面多余使用刀片修整<br>7.必要时激活美白剂<br>a.可以热水浴<br>b.活塞式的抽拉混合匀<br>c.组合混装上搅拌头<br>8.涂布美白凝胶<br>a.将凝胶均匀涂布在牙面上厚度1-2mm<br>b.根据材料种类作用时间8-15min<br>c.根据釉质通透性选择做1-2次（脱水性，明显，做一次，不明显，做两次。别做3次！）<br>9.去除牙髓保护剂<br>a.探针撬动保护剂<br>b.连同棉卷一起取下<br>10.美白后比色<br>术前术后<br>11.美白后术后指导<br>a.建议患者6小时候再使用含色素饮料食品<br>咖啡，红酒<br>b.服用布诺芬的患者有助于缓解术后敏感（现基本不用，术前检查详细）<br>c.诊室美白后24h内戴脱敏凝胶24h家庭美白。<br>(接下来是实操了）<br>①问诊：以前做过吗？有没有不舒服?是否孕期，哺乳期？是否服用药物？过敏史。牙齿颜色。<br>②术前拍照（正面，微笑），比色，比色照片，口内照片，口内牵拉比色照，黑背景照片。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/02.png"><br>③术区隔离<br>放棉卷，距龈缘5mm。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/03.png"><br>放侧面（一般到4）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/04.png"><br>气枪吹，打牙龈保护剂。沿龈缘，盖过牙龈1mm，别做太快，注意观察。4-4.<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/05.png"><br>光固化，移动式。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/06.png"><br>有间隙的，用牙龈保护剂彻底防护。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/07.png"><br>做墙，远中侧方垂直，棉卷边缘，与棉卷连接。将棉卷交界的地方封死。主要的目的是盖住牙龈，使其与下方棉卷无缝连接。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/08.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/09.png"><br>注射美白剂，35%HP，先打3，再打1，最后打2。上颌完打下颌。下颌先打3，再打2-2。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/09.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/10.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/11.png"><br>等待8分钟。医护要在椅旁做好监测。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/12.png"><br>用强吸吸去美白剂。先上颌后下颌。不好吸的美白剂用棉卷沾去。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/13.png"><br>注射第二遍美白剂。等待8分钟。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/14.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/15.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/16.png"><br>用强吸吸去美白剂。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/17.png"><br>用水打湿隔离棉卷。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/18.png"><br>用探针撬开牙龈保护剂，取出牙龈保护剂和棉卷。冲洗。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/006/19.png"><br>④术后拍照<br>(个人总结：本次课程主要讲的是家庭美白的托盘的制作。程序大概和正畸保持器的制作一样。正常患者用1mm的，夜磨牙的患者用1.5mm的。扇贝形设计，无储药区。还有诊室美白的实操。)</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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